摘要目的:评估强脉冲光(IPL)联合睑板腺按摩(MGX)(IPL/MGX)治疗睑板腺功能障碍(MGD)的短期疗效.方法:前瞻性临床研究.选择2016年11月至2017年12月于汉口爱尔眼科医院门诊连续就诊的MGD患者55例,最终完成随访的有48例(96眼),双眼均行IPL/MGX治疗,每3周治疗1次,共3次.在治疗前、治疗结束后1周进行眼表疾病指数(OSDI)问卷调查、泪膜破裂时间、角膜染色、睑板腺功能及成像、结膜眼红评分、共聚焦显微镜下睑板腺及蠕形螨检查等.使用配对t检验、Wilcoxon秩和检验及Spearman秩相关分析对数据进行处理.结果:IPL/MGX治疗结束后1周与治疗前比较,OSDI评分降低(t=2.300,P=0.024),睑板腺分泌能力与睑酯质量均得到改善(Z=-3.617,P<0.001;t=2.472,P=0.017),角膜染色评分、球结膜眼红评分降低(Z=-2.757,P=0.006;t=2.040,P=0.044),睑板腺腺周炎症细胞密度下降(t=4.765,P<0.001),睫毛根部蠕形螨总数减少(t=2.121,P=0.037).睑板腺萎缩面积<50％的MGD患者,治疗后症状评分、眼表炎症状态及睑板腺功能显著改善,睑板腺萎缩面积≥70％的MGD患者,治疗前后各项指标均未见明显改善.结论:IPL/MGX可明显改善睑板腺萎缩程度尚轻的MGD患者主观症状及睑板腺功能,减轻患者眼表炎症,减少眼蠕形螨数量,降低眼表损害.

abstractsObjective: To evaluate the short-term therapeutic effect of intense pulsed light combined with meibomian gland expression (IPL/MGX) for the treatment of meibomian gland dysfunction (MGD). Methods: This was a prospective single-arm clinical study that included 55 MGD patients, in which 48 patients (96 eyes) finished the follow-up. IPL/MGX treatment was administered in both eyes, once every 3 weeks for 3 sessions. Testing was performed before treatment and 1 week after treatment and included the ocular surface disease index (OSDI), a questionnaire survey, tear film break-up time, corneal staining, meibomian gland function and imaging, conjunctival bulbar redness, confocal microscope examination of the meibomian gland and mites, etc. A paired t test, Wilcoxon rank sum test and Spearman rank correlation were used for statistical analysis. Results: Ocular surface disease index (t=2.300, P=0.024) meibomian gland expression score and meibum quality score (Z=-3.617, P<0.001; t=2.472, P=0.017), corneal staining score and bulbar redness score (Z=-2.757, P=0.006; t=2.040, P=0.044), inflammatory cell density (t=4.765, P<0.001), and total number of demodex mites in the follicle (t=2.121, P=0.037) were all improved after treatment. The patients with a meibomian gland dropout area of less than 50％ had significant improvement of subjective symptoms, ocular surface inflammation and meibomian gland function after treatment. Patients with a meibomian gland dropout area of more than 70％ showed no significant improvement before and after treatment. Conclusion: IPL/MGX can significantly improve the subjective symptoms and meibomian gland function of MGD patients with mild atrophy of the meibomian gland, alleviate the inflammation of the ocular surface, reduce the number of demodex mites, and relieve damage onthe ocular surface.